Schizophrenia - Management Of Schizophrenia Flashcards
What is a token economy?
A form of behaviour modification where behaviours are encouraged by selective reinforcement-> people given rewards (2ndry reinforcers) & can be exchanged for primary reinforcers
Who demonstrated a token economy?
Ayllon & Azrin
What was Allyon & Azrin’s demonstration of a token economy?
Trialled it in a ward of women diagnosed with SZ
Every time particpipants carried out a task e.g. making their bed, they were given a token with ‘one gift’ written on it which could be swapped for ward privileges
Number of tasks increased significantly
Why has the use of token economies diminished since the 1960s-70s?
Ethical issues, however they’re still the standard approach to managing SZ in many parts of the world
What is the rationale for token economies?
Trying to avoid institutionalised behaviour e.g. poor hygiene
What 3 categories of behaviours did Mateson et al identify that are tackled by token economies?
Personal care
Condition-related behaviours e.g. apathy
Social behaviour
What are the 2 major benefits of modifying institutionalised behaviours?
1) It improves the patients’ quality of life in a hospital setting
2) ‘Normalises’ behaviours -> makes it easier for people who have spent time in a hospital to adapt back into their life in the community
What is involved in a token economy?
Tokens (coloured disks) -> given to individuals when they’ve carried out a desired behaviour
Target behaviours decided on an individual basis -> Cooper et al (it’s important to know the person so they know the most appropriate target behaviours
Tokens swapped for rewards -> usually immediately after behaviour
What approach is a token economy modelled after?
Behaviourism -> operant conditioning
How are tokens secondary reinforcers?
They only have value once the person receiving them understands they can be used to obtain better rewards -> primary reinforcers
EVALUATION: What evidence is there to suggest that the token economy system is effective?
Glowacki et al -> identified 7 high quality studies (1999-2013) that examined the effectiveness of token economies & all showed a reduction in negative symptoms -> supports value of token economies
EVALUATION: What counter-evidence is there to suggest that the token economy system isnt effective?
7 studeies is small amount of evidence to suggest the effectiveness of a technique -> the file drawer problem (bias towards positive published findings because undesirable results have been ‘filed’ away -> serious question over effectiveness of token economies
EVALUATION: What is the problem with the ethics of token economy systems?
Gives professionals considerable power of control over the patient -> imposing ones norms onto another (problematic if target behaviours arent identifies sensibly) -> benefits can be outweighed by their impact on personal freedom & short-term reduction in quality of life
EVALUATION: How are alternative approaches a limitation of token economy systems?
Review (Chiang et al) -> art therapy a good alternative (high gain, low risk -> no side effects/ethical issues) -> NICE recommends it (shows it may not be best solution)
